AIDS, Identity, and Community: The HIV Epidemic and Lesbians and Gay Men

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Edited by: Gregory M. Herek & Beverly Greene

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  • Psychological Perspectives on Lesbian and Gay Issues

    • Lesbian and Gay Psychology: Theory, Research, and Clinical Applications

      Edited by Beverly Greene and Gregory M. Herek

    • AIDS, Identity, and Community: The HIV Epidemic and Lesbians and Gay Men

      Edited by Gregory M. Herek and Beverly Greene

    • Ethnic and Cultural Diversity in the Lesbian and Gay Community

      Edited by Beverly Greene

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    William A. Bailey (1959–1994)

    This volume is dedicated to the memory of Bill Bailey. As a congressional lobbyist for the American Psychological Association, Bill helped shape the response of the behavioral and social sciences to the HIV epidemic in the United States. He was a tireless fighter for the lesbian and gay community, people with AIDS, and persons at risk for HIV. Among his many accomplishments, Bill was instrumental in focusing government attention on the need for community-based HIV prevention programs, mental health services for people with AIDS, and research on hate crimes against lesbians and gay men. We will all miss him greatly.

    Preface

    This is the second volume of the annual series, Psychological Perspectives on Lesbian and Gay Issues, sponsored by the Society for the Psychological Study of Lesbian and Gay Issues (Division 44 of the American Psychological Association, or APA). My coeditor, Beverly Greene, and I hope that the volumes in this series will provide a forum for some of the best psychological scientists and practitioners to present their ideas and describe their empirical research and clinical insights on a variety of topics critical to a lesbian- and gay-affirmative psychology. Although the first book in the series contained chapters on a broad range of topics, we decided that subsequent volumes would be thematic. The present volume, the first to focus on a particular topic, is devoted to issues of identity, community, and the AIDS epidemic.

    Soon after this volume is published, we will enter the second half of the second decade of the AIDS epidemic in the United States. The physical toll taken by AIDS, of course, has been enormous: More than a quartermillion deaths have been reported in this country alone. Many of us have lost friends, partners, relatives, and neighbors to HIV disease. The toll on our profession also has been substantial. As far as I know, no formal tally exists of the number of psychologists, sociologists, psychiatrists, and others who have died from AIDS. Even informal counts, however, are staggering. I find now that my time at annual conventions of the APA and other professional associations inevitably includes moments of reverie about my colleagues and friends who are not in attendance—because they are dead or too ill to travel—or for whom this may be the last meeting.

    Of course, HIV irrevocably alters the lives of all whom it touches. But in addition to its physical effect as a virus, HIV has had a tremendous social impact. The epidemic has fundamentally altered life for gay men, lesbians, and bisexuals throughout the world. Many of us have directly witnessed the changes wrought by AIDS. For most of those who came out before the epidemic began, AIDS has changed how we think about ourselves, each other, and our communities.

    Others know about the differences between life before and since AIDS only indirectly. For those who have come of age or come out since the early 1980s, life as a gay, lesbian, or bisexual person has always been lived against a backdrop of AIDS and HIV. In their experience, the community has always been visited by disease and death. Especially for men in this cohort, sex has always been imbued with images of death and disease as well as life and communion.

    The contributors to the present volume have conducted their scientific inquiry or clinical practice against the backdrop of the epidemic. In completing their chapters they have attempted to address questions not only of the impact of AIDS on gay men, lesbians, and bisexuals but also of its impact on the very notions of gay identity and community.

    In the book's first chapter, Neal King offers a personal perspective on the epidemic. His description of how AIDS has blurred the boundaries between the professional and the personal will resonate with many readers. In the next chapter, Cynthia Gomez discusses the ongoing controversy about lesbians’ risk for HIV. As she explains, this debate is premised in part on many erroneous assumptions about the link between sexual identity and behavior. Just as the HIV epidemic has made evident the fallacy of equating men's professed sexual orientation with their sexual behavior, so too has it revealed the extent to which many lesbians have had sexual contact with men, have shared works for injecting drugs, or have otherwise engaged in behaviors through which HIV transmission is possible.

    In his chapter on the impact of attitudes on AIDS prevention, Theo Sandfort considers some questions about men that complement the previous discussion by G6mez about women. He reviews the empirical literature on HIV to identify what we know about the connection between identity as a gay or bisexual man, integration into a gay community, and HIV risk behavior. In the following chapter, Eric Glunt and I offer empirical data that amplify some of Sandfort's main points. We argue for the value of studying HIV-related sexual behaviors and psychological functioning with an approach that is sensitive to differences in personal constructions of identity and community.

    The next three chapters discuss some of the linkages between ethnic minority identity, sexual orientation, and sexual behavior. In his chapter on AIDS-related risks and same-sex behaviors among African American men, John Peterson reviews what we know about AIDS among Black gay and bisexual men. Next, Alex Carballo-Dieguez considers the multiplicity of identities manifested by Puerto Rican men who have sex with men. Kyung-Hee Choi and her colleagues consider the problem of AIDS risk and dual identity among gay Asian and Pacific Islander men in San Francisco. Each of these chapters illustrates the ways in which the experiences of ethnic minority men are shaped simultaneously by their experiences of being gay or bisexual (or simply having sex with men) and belonging to a community that is defined by race or ethnicity.

    In her chapter, Laura Dean describes the stressors faced by gay men in New York City in the era of AIDS. These include learning one's HIV status, experiencing antigay discrimination and violence, and losing lovers and friends to HIV. As Dean demonstrates, such experiences have been common among men in the sample that she recruited with the late John Martin, one of our valued colleagues lost to AIDS. It is reasonable to assume that her findings are descriptive of gay and bisexual men in other AIDS epicenters and perhaps in smaller communities as well. Mary Jane Rotheram-Borus and her colleagues consider how these and other stressors affect the coming out experiences of youth in the AIDS era. They describe the difficulties faced by lesbian and gay adolescents who, with few sources of support or affirmation for their sexual orientation, may be at increased risk not only for HIV infection but also for physical violence and psychological distress.

    Next, Robert Remien and Judith Rabkin consider psychosocial issues in long-term survival with AIDS. They emphasize the central role of community ties for maintaining survivors’ conviction that life has value despite their experiences with a progressing illness. Allen Omoto and Lauren Crain next describe the phenomenon of AIDS-related volunteerism, which has been a remarkable feature of the community's response to the epidemic. They bring to their study of this phenomenon the social psychological perspective of functionalism and consider how a matching of goals and experiences affects satisfaction among gay and lesbian volunteers.

    The final chapter was first drafted by William Bailey in 1993. Bill planned to argue strongly that the gay and lesbian community should make prevention its top AIDS-related priority. He felt that a prevention agenda was absolutely critical for the community's immediate survival and its long-term well-being. Unfortunately, Bill died of AIDS in 1994 before he could complete the chapter. His friend and colleague, Marina Volkov, finished it, using Bill's notes and based on her conversations with him before he died. I worked with her to edit the final version. From my own years of collaboration and friendship with Bill, I‘m certain that his evaluation of the final draft and of the entire present volume would have focused on one central question: How useful will it be in the fight to ensure the well-being of gay men, lesbians, and bisexuals in the 1990s?

    Of course, answering that question in advance of the book's publication is difficult. But I believe that Bill would have approved of this volume. We dedicate it to him.

    Finally, I wish to thank all of my colleagues who contributed to this volume and served as reviewers for each other's chapters. I also thank Mary Ellen Chaney for her invaluable production assistance and Terry Hendrix, Dale Grenfell, and the staff at Sage Publications for their assistance and patience. Finally, I thank Jack Dynis for all of his support and tolerance.

    While editing this volume I was supported in part by a grant from the National Institute of Mental Health (R01 MH49960), which also supported the research reported in my chapter with Eric Glunt.

    GregoryM.Herek
  • About the Editors

    Gregory M. Herek, PhD, is a Research Psychologist at the University of California at Davis. In addition to his ongoing study of the impact of AIDS on gay and bisexual men (described in a chapter in this volume), his empirical research has included studies of heterosexuals’ attitudes toward gay men and lesbians, violence against lesbians and gay men, public attitudes concerning the AIDS epidemic, and public education about AIDS. He has published numerous scholarly articles on these topics. In 1992, he coedited (with Kevin Berrill) Hate Crimes: Confronting Violence Against Lesbians and Gay Men (Sage) and wrote or coauthored 6 of the book's 18 chapters. A Fellow of the American Psychological Association (APA) and the American Psychological Society (APS), he received the 1992 Outstanding Achievement Award from the APA Committee on Lesbian and Gay Concerns. In 1989, he was the first recipient of APA Division 44's annual award for “Distinguished Scientific Contributions to Lesbian and Gay Psychology.” He is past chair of the APA Committee on Lesbian and Gay Concerns. His other professional involvements also have focused on lesbian and gay concerns and AIDS issues. In 1993, he testified on behalf of the APA and five other national professional associations for the U.S. House of Representatives Armed Services Committee hearings on gay people and the U.S. military. In 1986, he testified on behalf of the APA for the House Criminal Justice Subcommittee's hearings on antigay violence. He also has assisted the APA in preparing amicus briefs in court cases challenging the constitutionality of state sodomy laws, child custody for lesbian and gay parents, and military policies excluding lesbians and gay men.

    In addition, he has served as consultant and expert witness for numerous legal cases involving the civil rights of lesbians and gay men.

    Beverly Greene, PhD, is Associate Professor of Psychology at St. John's University in New York City where she maintains a private clinical practice. She received her doctorate in clinical psychology from the Derner Institute of Advanced Psychological Studies of Adelphi University in New York. She has served as Director of Inpatient Child and Adolescent Psychology Services and Clinical Assistant Professor of Psychiatry at Kings County Hospital in Brooklyn, and Supervising Psychologist-Clinical Assistant Professor of Child Psychiatry at the Community Mental Health Center of the University of Medicine and Dentistry of New Jersey at Newark. A Fellow of the American Psychological Association, she is the first recipient of the Association for Women in Psychology's 1991 Women of Color Psychologies Publication Award. She is also the recipient of Division 44's 1992 Award for Distinguished Professional Contributions to Ethnic Minority Issues, recognizing her development of scholarship on lesbian affirmative theoretical perspectives and clinical applications with African American women. She is a member of the editorial boards of Women & Therapy and Feminist Family Therapy, guest consulting editor of professional journals, and author and coauthor of a range of professional books and journal articles on psychotherapy with African Americans; the interactive effects of race, gender, and sexual orientation in the psychologies of women of color; applications of feminist psychology with diverse populations; and the development of curriculums in clinical psychology on cultural diversity in psychological services delivery. She is coedi-tor of Women of Color: Integrating Ethnic and Gender Identities in Treatment and coauthor of Abnormal Psychology in a Changing World.

    About the Contributors

    William A. Bailey was a congressional lobbyist for the American Psychological Association until his death from AIDS in 1994. Among his many accomplishments were ensuring that mental health services were included in the 1990 Ryan White CARE Act, facilitating the issuance of new HIV prevention guidelines for local state and health departments by the Centers for Disease Control and Prevention, and securing funding for the HIV/AIDS Mental Health Services Demonstration Program. He also was instrumental in ensuring that crimes based on sexual orientation were included in the 1990 Hate Crimes Statistics Act and in obtaining support for research on antigay violence from the National Institute of Mental Health. He was an active member of the board of directors of the National Gay and Lesbian Task Force from 1987 until shortly before his death. In 1994, the APA established the William A. Bailey Congressional Fellowship fund “in recognition of his advocacy on behalf of AIDS-related psychological research, training, and services.”

    Alex Carballo-Dteguez, PhD, received his doctorate in clinical psychology from the New School for Social Research. He is currently Assistant Professor of Psychology at Columbia University in New York City. His research activity focuses on men who have sex with men. He also maintains a private clinical practice.

    Kyung-Hee Choi, PhD, is an Assistant Research Psychologist at the Center for AIDS Prevention Studies (CAPS) at the University of California, San Francisco. She has conducted AIDS research for people of Asia and Asian descent in the United States since 1990. Her areas of interest are psychosocial factors associated with health risk, models of behavioral change, program evaluation, and survey research.

    Thomas J. Coates, PhD, is Professor of Medicine and Director of the Center for AIDS Prevention Studies (CAPS) at the University of California, San Francisco. He has been active in HIV prevention research and policy since the beginning of the epidemic. His work has been done in the United States and abroad.

    A. Lauren Crain, MS, received her BA from the University of Kansas and her MS from the University of California at Santa Cruz, both in psychology. She is currently completing her PhD at the University of Kansas, where her research interests include AIDS volunteerism, the self and self-presentational concerns. She is an active AIDS volunteer.

    Laura Dean, MS, is Director of the AIDS Research Unit in the Socio-medical Sciences Division of the Columbia University School of Public Health. She succeeds the late John L. Martin as the principal investigator of a landmark longitudinal study of the impact of the AIDS epidemic on New York's gay community. Her research findings on bereavement, sexual behavior, and the epidemiology of HIV have appeared in a number of anthologies and scholarly journals, including the Journal of Consulting and Clinical Psychology, American Behavioral Scientist, American Journal of Community Psychology, Social Science and Medicine, American Journal of Epidemiology, and the Journal of Acquired Immune Deficiency Syndromes.

    Eric K. Glunt, MA, PhD candidate, is a Postgraduate Researcher at the University of California at Davis, where he is currently directing a study of the relationship of community and identity to AIDS risk reduction and AIDS-related coping among gay and bisexual men in the Sacramento area. He is also a doctoral candidate in the environmental psychology program at the City University of New York. His past research, writing, and professional work have focused on community development, community education, participatory planning and low-income housing issues, and public attitudes about AIDS.

    Cynthia A. Gómez, PhD, is a Research Specialist at the Center for AIDS Prevention Studies (CAPS) in the Department of Epidemiology and Biostatistics at the University of California, San Francisco. She received her master's degree in psychology from Harvard University and her doctorate in clinical psychology from Boston University. Prior to coming to CAPS, she spent 12 years working in community health settings, including 5 years as director of a child and family mental health center in Boston. She also consulted to schools and community agencies regarding HIV/AIDS prevention models and facilitated long-term support groups for physicians working with HIV/AIDS infected persons. Currently, she works as coinvestigator on projects geared primarily toward HIV/AIDS prevention in the Latino population, including projects focused on women, inmates, and school-based HIV prevention curricula targeting sixth graders. She is a member of the National AIDS Education Leadership Council, a committee of Latina women working to bring national attention to the issues for Latina women and AIDS. Most recently, she was appointed to the Committee on Psychology and AIDS (COPA) of the American Psychological Association and has been elected cochair of the HIV Prevention Planning Council for the city of San Francisco.

    Joyce Hunter, MSW, is with the HIV Center for Clinical and Behavioral Studies at Columbia University and the New York State Psychiatric Institute. She is former Director of Social Services at the Hetrick-Martin Institute, Inc., and cofounder of the Harvey Milk High School in New York.

    Neal King, PhD, is a psychologist in private practice in Berkeley, California and Associate Professor of Psychology in the Graduate School of Professional Psychology of John F. Kennedy University in Orinda, California. He works nationally with various aspects of men's issues in psychology. His book, Speaking Our Truth, was published in 1995.

    Steve Lew is Executive Director of the Gay Asian Pacific Alliance HIV Project (GCHP) in San Francisco. He also serves on the San Francisco HIV Services Planning Council and the HIV Prevention Planning Council and the Campaign for Fairness, a national policy campaign on behalf of gay men of color. He has been working with the gay Asian and Pacific Islander community as an advocate and health educator since 1987.

    Allen M. Omoto, PhD, is Associate Professor of Psychology at the University of Kansas. His area of specialization is social psychology, and his research interests include volunteerism (especially AIDS volunteerism), emotional and cognitive processes in interpersonal relationships, and stereotyping and prejudice. He has served as an AIDS volunteer for several years.

    John L. Peterson, PhD, is Associate Professor of Psychology in the Community Psychology Graduate Program of the Department of Psychology at Georgia State University in Atlanta. His areas of interest are prevention research and stress and coping research related to HIV/AIDS among African Americans. His current research includes studies that examine the prevalence and correlates of HIV risk behaviors, the effects of experimental interventions to change high-risk behaviors, and the processes of coping with HIV-related stress. His recent publications include articles in the American Journal of Public Health, Family Planning Perspectives, AIDS Education and Prevention, and Ethnicity and Disease and the book Preventing AIDS: Theories and Methods of Behavioral Interventions (coedited with Ralph DiClemente).

    Judith G. Rabkin, PhD, MPH, is Professor of Clinical Psychology in Psychiatry at the College of Physicians and Surgeons, Columbia University, and Research Scientist at the New York State Psychiatric Institute. She has been conducting research concerning psychiatric and psychological aspects of HIV since 1988 and currently is principal investigator of three NIMH grants in HIV-related areas. With Professor Robert Remien and Mr. Wilson, she is the author of Good Doctors, Good Patients: Partners in HIV Treatment (1994).

    Robert H. Remien, PhD, is Assistant Professor of Clinical Psychology in Psychiatry at the College of Physicians and Surgeons, Columbia University, and Research Scientist in the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University. Much of his research is focused on characteristics of HIV and AIDS long-term survivors, ways of coping with HIV illness, and the development of secondary prevention programs for people living with HIV and AIDS, including male HIV serodiscordant couples. He also maintains a part-time clinical practice.

    Margaret Rosario is affiliated with the HIV Center for Clinical and Behavioral Studies at Columbia University and the New York State Psychiatric Institute.

    Mary Jane Rotheram-Borus, PhD, is Professor in the Department of Psychiatry, Division of Social Psychiatry at the University of California Neuropsychiatric Institute in Los Angeles. Her major fields of research with adolescents include suicide prevention, HIV prevention, ethnic socialization, and mental health services access and use. In 1990, the American Medical Association awarded her for excellence in prevention of Hrv’ among adolescents.

    Nilo Salazar is an independent consultant in San Francisco. He was a cofacilitator of the Gay Asian Men's Support Group at the Pacific Center for Human Growth in Berkeley, California in 1987. He was also a founding member of the Gay Asian Pacific Alliance (GAPA) in San Francisco, of which he was an active member from 1988 to 1993.

    Theo G. M. Sandfort, PhD, is Director of the Department of Gay and Lesbian Studies at Utrecht University, The Netherlands. As a social psychologist, he has done research on pedophilia, sexual abuse, and sexual development. He currently studies sexual behavior in the context of AIDS among gay men as well as in the general population.


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